Temporal decline in post-discharge heart failure hospitalization after acute myocardial infarction in the contemporary era: insights from the Mie ACS registry

Background Nationwide European registries have reported a significant temporal decline in post-discharge heart failure hospitalization (HFH) following acute myocardial infarction (AMI), reflecting advances in acute management and secondary prevention. However, contemporary long-term data focusing specifically on post-discharge HFH in Japanese AMI populations remain limited. Purpose To clarify temporal trends in post-discharge HFH and its prognostic impact in a contemporary Japanese AMI cohort. Methods Among 6,394 consecutive AMI patients registered in the Mie ACS Registry between January 2013 and December 2022 who survived to hospital discharge, the cumulative incidence of HFH within 2 years was evaluated. Temporal comparisons were performed between the early (2013–2017) and late (2018–2022) periods. The association between HFH and 2-year all-cause mortality was assessed using multivariable Cox regression analysis. Results The cumulative incidence of HFH was 2.7% at 1 year and 3.4% at 2 years. HFH occurred predominantly within the first year after discharge, with a 3.7-fold higher incidence compared with the second year (P<0.001, Figure1). The first-year HFH incidence was significantly lower in the late period than in the early period (2.2% vs. 3.2%, P<0.001, Figure1), whereas no significant difference was observed during the second year (0.6% vs. 0.8%, P=0.33, Figure1). Patients who developed HFH within the first year had markedly higher 2-year all-cause mortality compared with those without HFH (30.8% vs. 6.0%, P<0.0001, Figure 2). Furthermore, HFH within the first year was identified as the strongest independent predictor of 2-year all-cause mortality (HR 2.38, 95%CI 1.70–3.30, P<0.001). Conclusion In this contemporary Japanese AMI cohort, post-discharge HFH significantly declined over time, particularly within the first year after discharge. Early HFH remains a powerful predictor of subsequent mortality, underscoring the importance of intensive early post-discharge management and optimized secondary prevention to further improve long-term outcomes.